The Keio Journal of Medicine (Keio J Med )

Publisher: KeioĢ„ Gijuku Daigaku. Igakubu

Description

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  • 5-year impact
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  • Website
    Keio Journal of Medicine website
  • Other titles
    Keio journal of medicine
  • ISSN
    0022-9717
  • OCLC
    1755059
  • Material type
    Periodical, Internet resource
  • Document type
    Journal / Magazine / Newspaper, Internet Resource

Publications in this journal

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    ABSTRACT: Cortico-muscular coherence was compared during ramp-and-hold isometric and quasi-isotonic contraction of the ankle joint in human subjects. EEG was recorded from the leg area of the motor cortex. EMG was recorded from the tibialis anterior (TA) muscle. The subjects were requested to maintain a steady low level of dorsiflexion and at intervals of 10 s to increase the contraction level within 1 s, maintain this level for 4 s and then decrease the level of contraction again within another 1 s. In seven subjects coherence in the 15-35 Hz frequency band was seen between EEG and TA EMG during low-level tonic dorsiflexion. In all subjects coherence disappeared during the ramp phase for both isometric and quasi-isotonic contraction. Coherence at other frequencies was also not observed in any of the subjects during the ramp phase. During the hold phase at the stronger level of contraction coherence reappeared quickly and had the same size as at the low level of contraction. However, a significantly larger level of coherence was found during quasi-isotonic than during the isometric contraction. This demonstrates that cortico-muscular coherence in the 15-35 Hz frequency band is phase- and task-related. The decrease in 15-35 Hz coherence during the ramp phase may be related to event-related desynchronization of EEG activity. The larger level of coherence during quasi-isotonic contraction may reflect a higher demand of precise control of the joint position. It may also reflect a greater need for binding of functionally related cortical pyramidal tract neurons.
    The Keio Journal of Medicine 04/2008; 57(1):50-6.
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    ABSTRACT: Intersubjectivity is an approach to the study of social interaction viewed from a perspective which rejects the view that reducing any such analysis to study at the level of the individual is adequate to address the issues of social functioning. It also stresses the view that social processes cannot be reduced to cognitive ones - most of the important questions in the study of developmental psychopathology deal with issues which have commonality with many other species and are patent well before the ontological emergence of 'cognitive' abilities. In this paper we review the evidence in this area, and discuss a range of issues relevant to autistic spectrum disorders. We focus in particular on social interaction; the role of the Intrinsic Motive Formation and recent work on mirror neurons in autism; genetic and teratogenic factors in the genesis of autism; and the role of a number of biological factors in pathogenesis - tryptophan; vitamin B12; sterol metabolism; glutamate and GABA; and the Fragile-X expansion.
    The Keio Journal of Medicine 04/2008; 57(1):15-36.
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    ABSTRACT: This paper derives from a grounded theory study of how Medical Directors working within the UK National Health Service manage the moral quandaries that they encounter as leaders of health care organizations. The reason health care organizations exist is to provide better care for individuals through providing shared resources for groups of people. This creates a paradox at the heart of health care organization, because serving the interests of groups sometimes runs counter to serving the needs of individuals. The paradox presents ethical dilemmas at every level of the organization, from the boardroom to the bedside. Medical Directors experience these organizational ethical dilemmas most acutely by virtue of their position in the organization. As doctors, their professional ethic obliges them to put the interests of individual patients first. As executive directors, their role is to help secure the delivery of services that meet the needs of the whole patient population. What should they do when the interests of groups of patients, and of individual patients, appear to conflict? The first task of an ethical healthcare organization is to secure the trust of patients, and two examples of medical ethical leadership are discussed against this background. These examples suggest that conflict between individual and population needs is integral to health care organization, so dilemmas addressed at one level of the organization inevitably re-emerge in altered form at other levels. Finally, analysis of the ethical activity that Medical Directors have described affords insight into the interpersonal components of ethical skill and knowledge.
    The Keio Journal of Medicine 04/2008; 57(1):37-44.
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    ABSTRACT: Standard screening of melanoma patients is a useful tool for predicting outcome of patients, however, an instant methodology for exact detection of subclinical disease or monitoring treatment response is under investigation. Detection of circulating melanoma cells is, therefore, a possible novel promising staging method. However, inconsistent data on method sensitivity and on the predicted patient outcome has been shown repeatedly. Recently, a multimarker real-time RT-PCR methodology for quantification of five melanoma markers Melan-A, gp 100, MAGE-3, MIA and tyrosinase was described by our group. In the current prospective trial, blood specimens of 65 patients with AJCC stage IIB-III cutaneous melanoma after surgery were periodically examined. In the above group, 27 % of subjects relapsed during the study. Prior to the disease progression we could observe a statistically significant tumor marker elevation in previous 0 to 9 months in all patients with clinical relapse. MAGE-3 became the most sensitive progression marker. During progression, three concordant positive markers were seen in 39 % of patients, followed by two concordant positive markers in 28 % and 1 marker in 33 %. This study supports the use of a multimarker real-time RT-PCR as a disease progression predictor. The dynamic assessment of serially obtained blood specimens represents a useful method for early metastasis detection and treatment response of melanoma patients.
    The Keio Journal of Medicine 04/2008; 57(1):57-64.
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    The Keio Journal of Medicine 04/2008; 57(1):1-14.
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    ABSTRACT: Premature birth rate and low birth weight rate are increasing in industrialized countries including USA and Japan. The Infant mortality rate (IMR) is three times and 50-75 times greater for infants born at 32-36 weeks and <32 weeks respectively than term-born counterparts. In the U.S., the IMR is greater than in Japan particularly among black infants and simply the "lower socioeconomic class" is not the answer. Premature birth is heterogeneous in origin and idiopathic in 70% of the cases. Increased utilization of assisted reproductive technology only accounts for a part of the recent trend. Evidence suggests environmental factors play a significant role, and genetic-environmental interaction is plausible. A chronic psychosocial stress of pregnant women has been postulated to be modifying the endocrine milieu thereby influencing pregnancy outcomes. In a preliminary observation in St. Louis, homeless pregnant women with high behavioral and social risks, when accommodated in a shelter home designed for these women, produced significantly less numbers of premature and low birth weight infants as compared with the general population. Furthermore, in a randomized controlled study in Washington DC, psychobehavioral intervention specifically targeting smoking (primary and secondary), intimate partner violence (IPV), and depression among black pregnant women significantly decreased the rate of miscarriage and low birth weight. These reports may have significant implication to the Japanese situation. Increasing number of Japanese women at reproductive age are exposed to smoking, may have underling psychosocial stress and may suffer from subclinical depression and/or from IPV. Detailed epidemiological studies of women before and during the reproductive age with regard to risk factors can lead to an effective intervention strategy against premature birth in Japan.
    The Keio Journal of Medicine 03/2008; 57(1):45-9.
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    ABSTRACT: The Muribushi Project in Okinawa, Japan, is breaking new ground for residency training in Japan by explicitly emphasizing clinical skills training and primary care. The core philosophy of the Project is defined by seven "concepts" that commit to (i) establishing cooperation between several hospitals to educate good clinicians; (ii) providing the best learning environment at multiple training sites; (iii) following global standards of practice; (iv) focusing on primary and emergency care of common diseases; (v) emphasizing faculty development through international exchange; (vi) providing residents with opportunities to obtain training abroad; and (vii) improving the quality of medical care through residents. Observations by the author during two week-long visits, one year apart, reveal that the Muribushi Project is fulfilling conceptual goals (iv), (v) and (vi) by emphasizing primary care and encouraging international exchange for faculty and students. The opportunity exists to fulfill goals (i) and (ii), but it is not being exploited because programs at member hospitals are not integrated, so that residents spend the duration of their residency at one location, and there is no formal system of rotations that would broaden their clinical experience. The Project is failing to meet a sixth goal of following global standards of care (goal #iii) and it is too early to say if it's pioneering approach to residency training is having an impact on healthcare in Japan (goal #vii). On balance, the Project's success in implementing elements of its core philosophy for residency training in the tradition-bound environment of Japan is particularly laudable.
    The Keio Journal of Medicine 01/2008; 56(4):111-23.
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    ABSTRACT: The Meiji Jingu Baseball Stadium attracts a large number of spectators in the Tokyo metropolitan area. To clarify the demand for medical care at a public ballpark, we analyzed following two types of medical records maintained at the stadium: (1) "Report of Aid": a record of patients visiting the first-aid station in 2003 season and (2) "Report of Accidents": a record of patients referred to clinics/hospitals between 1996 and 2003 season. (1) In 2003, approximately 1,582,000 spectators watched 67 professional baseball games (60 night games). Of the 247 spectators received medical care at the first-aid station (3.7 persons per game, 1/6,405 spectators), 128 (51.8%) had trauma and 109 (44.1%) had illness. The incidence of trauma was relatively higher before the start and near the end of the night games. The risk of becoming sick/wounded per spectator or the number of the sick/wounded per game differed depending on the participating sports teams. (2) Ninety-three spectators referred to clinics/hospitals during the 8-year period from 1996 to 2003, of which 57 were transferred by ambulance. Direct ball injury accounted for 65 (69.9%) cases of trauma, followed by stumbling/falls (18 cases, 19.4%). Twenty patients were diagnosed to have fractures at the clinics/hospitals. Intrinsic cardiopulmonary arrest occurred in one spectator. Trauma due to direct ball injury accounted for the largest number of wounded patients referred to clinics/hospitals. Treatment to patients at the first-aid station in the stadium may optimize the frequency of hospital visits. Records of medical care are effective to analyze the demand for medical preparedness.
    The Keio Journal of Medicine 10/2007; 56(3):85-91.
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    ABSTRACT: Exact parallels can be drawn between the shortcomings in medical education in the US in the 80s and those prevalent in Japan today. Research and clinical practice had primacy over teaching, and primary care medicine, with its focus on humanistic principles, was subordinated to specialization and tertiary care. US medical schools undertook a wide-ranging reform of the traditional curriculum, recognizing its four major shortcomings. These were (i) an institutional failure to accord academic status to teaching, resulting in a disincentive to teach, (ii) a failure by faculty to perceive a shared interest in education, resulting in teaching that was fragmented and even contradictory, (iii) a failure to integrate preclinical and clinical material, resulting in fragmented learning, (iv) a failure to encourage the development of the most important attributes of a physician (independent thinking, problem solving, and self-directed learning). The reform of medical education in the US was achieved through a wholesale restructuring that (i) integrated basic science with clinical medicine across the curriculum; (ii) coordinated teaching across departments by organizing the curriculum into "blocks"; (iii) integrated problem based instruction into the curriculum to encourage active learning; and (iv) elevated the importance of both teaching and primary care. The successful effort to reform medical education in the US can serve as a source of encouragement and a road map for academic institutions in Japan, like Keio University, who recognize the same shortcomings in Japanese medical education and are attempting to develop and implement a curriculum that is more integrated and problem-oriented.
    The Keio Journal of Medicine 10/2007; 56(3):75-84.
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    ABSTRACT: Medical systems in the USA such as EBM., DRG., Informed Consent and Second Opinion have already been introduced into the Japanese medical system. However, some of these systems have met resistance from a part of the population due to the differences of social structures, morals and customs between the two countries. Briefly, I described the medical education and licensure, the private practice and "open hospital system" of the USA. The following 4 topics which drew great interest in Japan will be discussed. 1) CEREBRAL DEATH AND BIOETHICS: Cerebral death has been restrictively accepted as human death since the 1980's only in terms of terminal cares in clinical medicine. The rather simplified current neurological criteria for death are approved in the USA. In order for an organ transplant to take place, a potential donor must be diagnosed as brain dead. However, Japanese society has not accepted the concept of cerebral death completely because of an accident in the 1960's where an organ was improperly removed when the donor who was not in the state of brain death. Recently, more people in Japan are showing interest in Dignity and Euthanasia from the point of view of "Right to die". 2) MALPRACTICE AND LITIGATION: "To err is human" was introduced by the Institute of Medicine for Risk Management. Accidental deaths of patients under medical care ranks No.8 in total number of deaths in the USA. There are 100,000 malpractice cases in the "Lawsuit Society" of America, which is 100 times that of Japan. Furthermore, the legal fees and insurance premiums are extremely high in the US as opposed to very low in Japan. 3) HEALTH CARE INSURANCE: To reduce medical costs, the insurance companies introduced "Competitive Managed Care" which resulted in the formation of "Health Maintenance Organizations" (HMO). Furthermore, when you compare the two countries in respect to those who have health insurance, 44 million in the USA carry no health insurance, whereas in Japan, the government cover for everybody's health insurance. 4) DISCLOSURES IN THE USA: Medical bills and statements are sent to all patients. Maintenance records belong to the patient. The Medical Board discloses those physicians who are facing disciplinary action.
    The Keio Journal of Medicine 10/2007; 56(3):96-101.
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    ABSTRACT: A number of Western physicians have highlighted shortcomings in Japanese medical education over the years. In recent years, however, there has been dramatic change in the system of medical education in Japan that renders some of these observations inaccurate and others worthy of several caveats. Using a recent review article in the Keio Journal of Medicine as a starting point for discussion, the author responds to a number of historical concerns about medical education in Japan and includes updated information on recent reforms.
    The Keio Journal of Medicine 07/2007; 56(2):61-3.
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    ABSTRACT: We performed single photon emission computed tomography (SPECT) of the brain in 15 patients with chronic pain (males, 7; females, 8; average age 49.1 +/- 17.9 years) and identified the locus of cerebral blood flow reduction by a new analytical method (easy Z-score Imaging System: eZIS) to clarify the functional neuroanatomical basis of chronic pain. Of the 15 patients, 6 had backache, 2 neck pain, 2 gonalgia, and 5 pain at other sites, with an average Visual analog scale of pain (VAS) value of 6.1 +/- 1.9. In comparison with a information on a data base on physically unimpaired persons, the dorsolateral prefrontal area (both sides, right dominant), medial prefrontal area (both sides), dorsal aspect of the anterior cingulate gyrus nociceptive cortex (both sides) and the lateral part of the orbitofrontal cortex (right side) were found to have blood flow reduction in the group of patients with chronic pain. As for chronic pain and its correlation with clinical features such as a depressive state, anticipation anxiety, PTSD, and conversion hysteria, the mechanism in the brain that was suggested by this study should be followed-up by functional neuroimaging studies.
    The Keio Journal of Medicine 07/2007; 56(2):48-52.
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    ABSTRACT: It has been hypothesized that dysregulated host/microbial interactions play a pivotal role in the pathogenesis of inflammatory bowel disease. However, the exact mechanisms underlying the induction and perpetuation of the intestinal disorder are unclear. Recently, we unexpectedly discovered significantly upregulated gene expression of chitinase 3-like-1 in inflamed colon of the dextran sulfate sodium-induced colitis model by employing the DNA-microarray analysis. Chitinase 3-like-1 has a chitin binding ability, but lacks the enzymatic activity of lysing microbial cell wall. Chitinase 3-like-1 protein is mainly expressed in colonic epithelial cells and macrophages in the inflamed colon of dextran sulfate sodium-induced colitis. Chitinase 3-like-1, which can be upregulated after pro-inflammatory cytokine stimulation, possesses an ability to enhance the adhesion and internalization of intracellular bacteria into colonic epithelial cells. Most importantly, in vivo neutralization of chitinase 3-like-1 significantly suppressed the development of dextran sulfate sodium-induced colitis by dramatically decreasing the bacterial adhesion and invasion into colonic epithelial cells. Furthermore, anti-chitinase 3-like-1 antibody-treated mice exhibited a significantly lower load of Salmonella typhimurium in peripheral organs as compared to control rabbit IgG-treated mice. Recently, it has been reported that acidic mammalian chitinase is expressed in the setting of T helper-2-associated inflammation and subsequently induces airway hyperresponsiveness in allergic asthma patients. In addition, pan-chitinase inhibitor significantly ameliorates T helper-2-mediated inflammation and airway hypersensitivity. These studies provide to be a novel insight into the physiological role of mammalian chitinases in host/microbial interactions, and inhibition of chitinase activity would be considered a novel therapeutic strategy of allergic and inflammatory disorders.
    The Keio Journal of Medicine 04/2007; 56(1):21-7.

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